Cardiovascular Effects of Sevelamer in Stage 3 CKD

• DOI: 10.1681/asn.2012070719
• Publication Date: 2013-04-19T05:15:07Z
• Authors: Colin D. Chue; Jonathan N. Townend; William E. Moody; Daniel Zehnder; Nadezhda A. Wall; Lorraine Harper; Nicola C. Edwards; Richard P. Steeds; Charles J. Ferro
• Keywords: Sevelamer

Serum phosphate independently predicts cardiovascular mortality in the general population and CKD, even when levels are normal range. Associations between serum phosphate, arterial stiffness, left ventricular (LV) mass suggest a possible pathophysiological mechanism, potentially mediated by phosphaturic hormone fibroblast growth factor-23 (FGF-23). To what extent binder sevelamer modulates these effects is not well understood. In this single-center, randomized, double-blind, placebo-controlled trial, we enrolled 120 patients with stage 3 nondiabetic CKD. After 4-week open-label run-in period, during which time all received carbonate, randomly assigned 109 to (n=55) or placebo (n=54) for an additional 36 weeks. We assessed LV systolic diastolic function magnetic resonance imaging echocardiography, stiffness carotid-femoral pulse wave velocity. The mean age was 55 years, eGFR 50 ml/min per 1.73 m(2). 40 weeks, found no statistically significant differences regard mass, function, Only 56% of subjects took ≥ 80% prescribed therapy; compliant subgroup, treatment associated lower urinary excretion FGF-23 but klotho, vitamin D, cardiovascular-related outcomes interest. conclusion, study does provide evidence that carbonate improves